HomeMy WebLinkAboutPlumbing Permit 13. 1075 i
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fo CITY OF PRIOR LAKE PLUMBING PERMIT
V
474,TES
I. d ei1e Date Rec'd
PERMIT NO. it 2. Gold cry ��'- '�—
(Please type or 3. Yellow Applicant P�
(P typ print and sign at bottom)
ADDRESS ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION pJD
OWNER /
(Name) 11 Altai (Phone) # • - r — I►_, _%
(Address) , "Mg
APPLICANT
(Name) Appliance Connections Inc. (Phone)
(Address) 12850 Chestnut Blvd.
Sh ' • .
.cc, MN 55379
,.'' SNA5 -i•03 (City) (Zip Code)
(Contact Persons • • 4 ► ' SA, 4 (Phone)
APPLICANT SIGNATURE , *. .%1A / DATE c aS bot3
1
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher 1 Water Heater
Floor Drain Water Softener
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (1 or 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet (Toilet) Other
FEE SCHEDULE
Industrial, Commercial & Multi- family 1% of job cost with a $49.50 minimum Residential, New One & Two - Family $149.50
Residential, Additions & Alterations $49.50
The Minnesota Statutes § 326B.148
"SURCHARGE" has been extended $ Building Permit #
The minimum surcharge for a
'LUMBING PERMIT FEE $ ��
"fixed fee" permit is $5.00 ;TATE SURCHARGE $ - '
OTAL PERMIT FEE $
(Office Use Only) GY, —
This Application Becomes Your Building Permit When Approved Paid A . _, / 3 -- V Receipt No. 7v/0 2 _
Buildine Official Date Date 43 By q
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
- .4,40=3413r, - se , MMT 43 * 4 . 3 WW*111. - MIMMIlleh=.Qtra.„
r AICICIA
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